Welcome to The Nanaimo Blues Festival

Nanaimo Blues Society
Membership Application Form

Please Select a Nanaimo Blues Society membership type:

$5.00 for youth (plus HST = $5.60)
$15.00 for singles (plus HST = 16.80)
$20.00 for a family (plus HST = $22.40)

After you have filled in your information in the form and pressed the submit button below, you will be contacted by email regarding payment using PayPal. In the email will be a link to the PayPal website where you can pay using your PayPal account. if you don't have a PayPal account, you can also pay at the same site by Visa or MC.

If you don't want to use PayPal, you can just send a cheque made out to: Nanaimo Blues Society and mail to Nanaimo Blues Society, P.O. Box 306, Nanaimo, BC V9R 5L3.

THANK YOU FOR YOUR SUPPORT AND KEEPING THE BLUES ALIVE IN NANAIMO.

* indicates required field

How do you want to pay? *

PayPal

Cheque

First name:

Last name:

Address:

City:

Province:

Postal Code:


Home Phone:	*	Work Phone:
Mobile Phone:		Fax:
Email Address:	*

Are you interested in volunteering?

Yes:

No: *